Physician Well Being:Survival Strategy for Working With

Underserved Populations

Martha Sosa-Johnson M.D.UCI- Division of General Internal MedicineApril 9, 2008

Presentation Objectives

• Discussing factors that positively and negatively affect physician well being

• Understanding the deleterious consequences that can occur when physicians’ sense of well being is negatively affected.

• Identifying positive coping mechanisms for working with underserved populations

Background

• Olive View Medical Center/VA Sepulveda– Internal Medicine

Residency– Internal Medicine Attending

– 1990-1995

• Pacoima/Granada Hills, San Fernando Valley– Private Practice 1995-1999

• UCI-– Anaheim Family Health

Center,1999 – July 2007– Pavilion 3 at UCI Medical

Center , 8/07 to present

What factors are negatively related to physician well being?

Studies on Physician Well Being

– Increased paperwork and red tape

– Lack of perceived control among physicians was the best predictor of burnout

(Western Journal of Medicine, 2001;174:13-18)

Studies on Physician Well being

• 1998 Physician Resource Questionnaire by Canadian Medical Association indicated a serious decline in physician morale– Volume of work– Sleep deprivation– Teaching and research demands– Potential for litigation– Increased demands of the public

West J Med.2001;174:5-7

Studies on Physician Well being• In-depth interviews with

54 members of the Department of Medicine (DOM) at the University of Calgary

• Short questionnaire sent to all members of the DOM and residents (N=275) and 182 surveys returned

• Questions about quality of life, job satisfaction, stress and coping

Negative determinants of physician well being

• excessive work hours and work to family conflict

• Work overload and emotional stress/demands of patient care

Jean E. Wallace (Department of Sociology) and Jane Lemaire (Department of Medicine)University of Calgary, 2005

“The hours. My youngest son when he was about three-years old, he said to me one day “Mommy, I wish you were just a mommy and not a doctor”.”

Jean E. Wallace (Department of Sociology) and Jane Lemaire (Department of Medicine)University of Calgary, 2005

“Oh, being at three places at once, so the time pressure of, you know, being late in clinic, having patients waiting. You’re an hour behind, they’re getting grumpy, you have to take a phone call, you can’t stay on schedule. Then the unpredictability of the workday, on the ends, so getting home on time, I find that most stressful.”

Jean E. Wallace (Department of Sociology) and Jane Lemaire (Department of Medicine)University of Calgary, 2005

Physician Well Being and Professional Behavior

Minnesota Medicine. Physician Well-being and Professionalism: Colin P. West, M.D.,PhD., and Tait D. Shanafelt, M.D.

Consequences of Physician Distress

• Substance related disorder: 8%-12% of health professionals– Physician addiction is usually advanced before

becomes noticeable in workplace– Addiction often shielded by “code of silence” among

physicians who often do not confront colleagues exhibiting symptoms of addiction

• Suicide rates alarming– Male physicians 2 times more likely to commit suicide

than average Americans– Female physicians 3 times more likely

Annals of Internal Medicine.2001;135:145-148

Consequences of Physician Distress

“On average, the United States loses the equivalent of an entire medical school class each year (approx 250 physicians) to suicide”.

Physician Suicide. Emedicine; March 14, 2007Louise B. Andrew, MD, JD, Medical-Legal, Risk Management and Trial Consultant

Does support from others buffer the negative determinants

on physician well being?

Yes, especially support from spouse and coworkers, but also from positive patient interactions

Jean E. Wallace (Department of Sociology) and Jane Lemaire (Department of Medicine) University of Calgary, 2005

What constitutes well being for practicing physicians?

“…to have a quality of life, you have to have a life outside of medicine. That’s the bottom line!

Jean E. Wallace (Department of Sociology) and Jane Lemaire

Department of Medicine) University of Calgary

Identifying positive coping mechanisms for working with underserved populations

Familiarize yourself with scope of services

UCI – FAMILY HEALTH CENTER, ANAHEIM

• Internal medicine • Family Medicine• OB/GYN • Pediatrics • Classes offered: diabetes • Nutrition consultation • Comprehensive prenatal services • Specialty programs available: Family PACT, Every

Woman Counts Program

Familiarize yourself with the different health plans accepted and

the health services covered by each health plan

• MSI (Medical Services for the Indigent)• Medicare

– Monarch One Care– Medicare only

• Cal-Optima– Managed Care– Direct

• Cash

Administrative Assistance

• Outside Resources– Radiology Centers– List of community board

certified specialists– Dental Referrals– Services available at

“sister” clinic, UCI Santa Ana Family Health Center, and the “Coalition of Community Clinics of Orange County”

Knowing limitation in resources

• www.needymeds.com - good source of information on patient assistance programs

• Knowing community resources (Walgreen’s Prescription Club $20/individual/yr or $35/family/yr- $12.99/90 day supply of generic meds or Target ‘s $4/month of selected generic meds).

Knowing limitations in resources

Important to realize when patient’s medical concerns can not be addressed in clinic setting.

Prioritize your time

*Get to work on time

*Address messages/refill requests in between patient visits

*Set a specific time for leaving each day

*Be comfortable saying “No” when you just don’t have the time

Taking care of yourself

Scheduling vacation every 3-4 months

*Taking off birthdays*Taking a few days off for wedding anniversary*Remembering special relationships*Making time to attend special events

Exercise

Taking care of yourself

• Taking care of your own medical needs as they arise

• Self care is not a part of the physician’s professional training

• Typically low on list of priorities• 1/3 of physician’s did not have

a doctor themselves according to a recent study that examined graduates of John Hopkins SOM

(Arch Intern Med.2000;160:3209-14)

Maintaining Relationships*Date night with significant other,

(including parent and me dates)

*Regular communication with family members and friends

**Relax and be yourself with someone who knows and likes you

**Isolation makes it harder to get the support that is essential for the very emotionally demanding job you have chosen

***Dedication and excellence not only during your workday but also with your family/friends

THE PHYSICIAN’SBALANCING ACT

Jean E. Wallace (Department of Sociology) and Jane Lemaire (Department of Medicine) University of Calgary, 2005